Lord Rooker: My Lords, the legislation just referred to by the noble Lord was agreed by his party. The implications of part of his question and of part of the question of the noble Lord, Lord Peyton, are no homes for people in the south-east, families driven away and no policy in this area whatsoever. They cannot have it that way. The Question was about machinery of government issues, not about the policies of the department.

Baroness Crawley: My Lords, that seems a bit of recipe for doing nothing—a wait-and-see policy perhaps. The noble Lord will know that the challenge is to keep the traffic flowing. Therefore, we must accept that congestion is on the increase, as the noble Lord, Lord Hamilton, said, and that it will continue to increase. The challenge is how we manage that increase. How do we ensure that people have, for instance, good information so that they know the best times to travel to avoid the difficult peak periods? How do we get our targets right for our motorways and large trunk roads, as well as for our local roads?

Baroness Crawley: My Lords, I do not agree with the noble Lord. We would encourage TOCs to join the secure station scheme, which I am sure is the scheme that he addressed. We want to involve more than the 300-odd stations that are in the scheme.
	In the new franchises—for instance, the Kent franchise and those for Thames Link, Great Northern and Great Western—the potential franchisee is now required to submit a security plan in the bid. They get nowhere near a bid until they submit a security plan dealing with a number of issues, such as the security of the customer and of stations. Those are then captured in the final franchise agreement. I would not say that we are not encouraging them.

Baroness Andrews: My Lords, I am grateful for the noble Baroness's clear reiteration of her position. She has raised a number of interesting points here and in Committee. Her final words were that she had no intention of blowing revaluation out of the water, but as I pointed out in Committee, this amendment would cancel revaluation altogether. That position is not only more definitive than that taken by her colleagues in the other place, but it means there can be no future revaluations ever. I know noble Lords opposite have shown a commitment to council tax, and are concerned about its credibility. The noble Lord, Lord Hanningfield, has made that very clear in Committee. I would have thought that their position as they have presented it is very problematic now.
	I want to allay the noble Baroness's concerns. She is concerned that it is an unfettered power. Let me first deal with the fact that it is not an entirely new power for the Secretary of State to set the date of and the timing between revaluations. As a veteran of the 2003 Act the noble Baroness will know that under existing provisions the Secretary of State already has the power to set the date of revaluations; he can do so at any point within the 10-year cycle. The only restriction on the timing of the use of the power is that if it is going to be used it must be used before the 10th anniversary of the previous revaluation. In other words, he already has complete flexibility to set the date of revaluations at any time, provided it is before the 10th anniversary.
	The Bill seeks simply to remove the 10-year maximum time frame between revaluations, and leave the Secretary of State with the power to determine when any future revaluation might happen. It is simply a variation on the previous power; it provides more flexibility.
	The noble Baroness also asked why we now seek to change the existing arrangement for the timing of revaluation. This was raised in Committee when the noble Lord, Lord Hanningfield, argued that we should simply bring forward a Bill that stopped the intended revaluation in its tracks and provided no power to set a new date. That is what the amendment did. He also suggests that we should wait until we receive Sir Michael's final report before making any changes. If we had taken the first route, and simply cancelled revaluation—and it is not a cancellation—without providing a power to set any future date we would have, in effect, cancelled revaluation for all time. We have made clear at every stage of this Bill that we have no intention of doing that. We are committed to postponing but not cancelling revaluation because we believe it is right to maintain a fair alignment between house prices and council tax bands. That is where the certainty lies.
	The noble Baroness pressed me on clarity. The whole point about postponing the council tax revaluation until we have the full findings and recommendations of the Lyons report—which is looking at form and function in local government in the context of a lot of changes as well as council tax funding—is precisely because we want to introduce more clarity into our deliberations on council tax revaluation when we take them. We will have the benefit, not only of his judgment but of the collective judgment of everyone who has taken part in that process. It is a generous and open consultation and from the interim report itself one can see how seriously and how widely Sir Michael is engaging with the process.
	We announced to the House at the earliest opportunity, in the light of that decision and the need to keep costs to a minimum, that preparatory work was stood down with immediate effect. I am sure that the noble Baroness would have been the first to challenge me about why we were letting the VOA run on with its work if revaluation had stopped. We had to act immediately to remove the statutory deadline. That in itself is clear and certain, too, because if we had not done that the VOA would have been in an impossible situation of remaining under the statutory obligation to revalue.
	Let me add one further point about clarity and certainty. Even if the Government had concluded—we have not—that revaluation was likely to take place in this Parliament, the revised timetable for Sir Michael's inquiry at the end of this year and the need to take full account of his work would have left insufficient time for us to consult on his recommendations and then come forward with a properly developed package of reforms and a date for revaluation. I therefore ask the noble Baroness to consider whether that is not a commitment to the greatest clarity in a process that we have laid down as clearly as possible.
	It was asked why we did not wait for Lyons. We thought it sensible that, while we were putting through this necessary legislation which I know the opposition support, we should also take the opportunity to remove the 10-year maximum timetable for revaluations. In doing that, we would provide Sir Michael Lyons with a clear field for his inquiry to come forward with such recommendations as he thinks appropriate and with no pre-existing constraints. That is an important definition of independence. However, in order to ensure that revaluation can happen at some point, we must give the Secretary of State a power so that we have the necessary mechanism in place for setting the date for revaluation. Nothing would have been gained by waiting for his report before we took legislative action.
	The noble Baroness expressed concern about the Secretary of State's unfettered powers. I am sure that we will return to the subject on other amendments, but I reiterate that this order-making power, which was passed by both Houses in 2003, is subject to the power of affirmative procedure in the other place. It is open to full scrutiny, debate and Division. It is not an unfettered power. This amendment would return us to a situation that denied us any chance in the future to update a council-tax system that would be based on increasingly out-of-date valuations and with no mechanism through which to address that without further recourse to primary legislation. That is not a sensible way forward and I do not believe that noble Lords opposite believe it is either. We need a system that allows the Government to proceed in due course in clarity, in the full light of Sir Michael's work and in the light of our recognition that the maintenance of a fair alignment between house prices and council tax is linked to wider questions about the structure of council tax and the operation of council tax benefit.
	I therefore hope that the noble Baroness will accept my reasons and reassurances and withdraw the amendment.

Baroness Hanham: My Lords, I return to an amendment that I moved in Committee. I noted that the noble Baroness, Lady Andrews, said that she thought that that amendment was "tautologous". That is a wonderful word, so I thank the noble Baroness for giving me the opportunity to use it again; it trips off the tongue. I went away to read her comments. Having done so, I am returning to this matter, because the crux of her argument came down to one revealing sentence, which I shall quote. She said that,
	"any revaluation could use only the existing banding structure, because there could be no change to bands until after a new valuation list had been compiled . . . Bills would be issued against this list because they would be bound to be, and only then would it be possible to make the necessary changes to band structure to account for inflation and any other reforms thought desirable".—[Official Report, 07/2/06; col. GC306.]
	There is an issue here. The whole point of the amendment was to ensure that the council bands could not be changed between now and a revaluation, or unless a revaluation was proposed.
	I suspect that this is not as much of a chicken and egg situation—I think that the words were "horse and cart"—as the Minister has suggested. Her words suggest that any other reforms that were thought desirable could be made after a revaluation had been completed. In bringing back this amendment, I believe that it would be short-sighted in the extreme to plan to have reforms as an afterthought to revaluation.
	It is hardly the fault of our Benches that the Bill allows for so little scope. If the Bill more comprehensively provided for the needs of council tax—which I know is not, and was never, its purpose, although it should have been—these issues would have been addressed; they are all interdependent.
	The amendment would ensure that the revaluation occurred before bands are changed. No decision can be made on council tax bands until a view of the full council tax valuation spectrum is available—if, indeed, it is required and necessary. From the Minister's explanation, the only thing that would work would be that council tax bills would be issued after a new valuation, although under the old banding scheme, which would mean that the people whose houses had risen up the bands would be hard hit. Can the Minister say what would prevent the Government from changing legislation so that Bills would be issued only after the new banding system was in place?
	The Minister described the complicated set of events that led to the final revaluation list. The amendment, far from confusing that process, is intended to bring an order to it, starting with the basic value and proceeding to the banding and then to the issuing of bills. Widening council tax bands disproportionately hits areas with high property values, which are not necessarily the same as areas of high income.
	We have seen council tax rising at twice the level of inflation per year—over 76 per cent since 1997. It is about time that the Government properly reassessed their local government finance strategy, which could take account of a revaluation if it became necessary. I beg to move.

Lord Hanningfield: Before the noble Baroness sits down, perhaps I may intervene, because she mentioned something that I said. Basically, we want to freeze the system for the moment. Given that the Government need the legislation to stop the revaluation, we do not want anything to happen with regard to moving bands or anything else until the Lyons review has reported and until there has been a big dialogue about the future. At the moment, for example, pensioner groups are refusing to pay council tax. I advise them to pay the tax; they should not be putting themselves in the position of going to prison. But the system is so unpopular that there has to be a big debate about how it goes forward.
	Basically, the amendments that we are putting forward are to ensure that there is no change in the bands and that nothing happens other than a cancellation of the revaluation until the Lyons review has reported. Then we will expect there to be further legislation, as my noble friend Lady Hanham said a little while ago. Our amendments are attempting to do that. They give the Government the powers that they need but, at the same time, they propose that we wait to see what happens. As I suggested, there are different ways of proceeding which the public might accept. Therefore, let us have a chance to have a dialogue about those things rather than put things in statute that are not necessary at the moment.

Baroness Hanham: I thank my noble friend for his intervention—as always, he was straight, succinct and practical. I also thank the Minister. I want to go away and read Hansard carefully. It is awful when one says that after having just listened to what someone has to say, but it seemed to me that the noble Baroness almost accepted our amendment. Although she did not stand up and say that she was accepting it, she implied that it was quite sensible that revaluation should precede any prospect of rebanding, changing the ratios or doing anything to the council tax.

Baroness Andrews: Perhaps I may put on the record now that I would not find it possible to accept the amendment. I said that it was unworkable and unnecessary.

Baroness Hanham: I thank the noble Baroness for that clarification. We may return to this matter but, for today, I beg leave to withdraw the amendment.

Baroness Scott of Needham Market: The Minister mentioned déjà vu and I am afraid that we are going to continue in that vein because we debated this amendment in Grand Committee. However, at that time, the noble Lord, Lord Bassam, who was replying on behalf of the Government, concentrated his remarks almost entirely on the question of property price divergence. Because of that, I have removed that element from the amendment, as I want to concentrate on the principles. I still contend that over time—let us remember that we are now using a base which is something like 14 years old—divergence of property prices is an important issue, but I have removed that because, as I said, I want to concentrate on the principles.
	The Minister said—I paraphrase—that the Bill does not fundamentally change the powers of the Secretary of State except to remove the obligation to revalue at 10 years. She is saying, "Well, what's all the fuss about?" It is precisely because the revaluation at 10 years has been removed that we see a problem, because the certainty of doing something within that timescale has been replaced by the power of the Secretary of State to revalue at any time in the future. That will be done by order, and only through the House of Commons.
	My amendment would require the Government to consider annually whether a revaluation is justified—moving from the position whereby the Government may order a revaluation to a position whereby they would have to consider it. They would report to Parliament and then on to the wider world on their deliberations. I am happy to concede that the period might be two or three years rather than annually, but I want the principle to be accepted. Putting it into the Bill would give a formal basis for consideration of what is, after all, a major piece of public policy that attracts a great deal of controversy. In the absence of the 10-year stop that was in the previous legislation, we need certainty, which reporting to Parliament would provide.
	The Minister said that this was not cancellation but postponement, which implies that there will be a revaluation. In Grand Committee, the noble Lord, Lord Bassam, said that the factors to be considered in determining the right time for revaluation were many and complex and that sadly we did not have a neat formula to give us the answer. Quite so. It is precisely because at no point in any of our debates have Ministers explained how the determination is to be made that we feel uneasy. Whether we are citizens, involved in local government or parliamentarians, we seem to be being asked to take on trust that such a system in government exists and that it is robust. It may well be, but we do not know that in the complete absence of any mechanism to report to Parliament how the Government are thinking.
	If the Government are confident that they have robust systems, they have nothing to fear from coming to Parliament now and again and being transparent about their thinking on revaluation. If they are not confident but wish to base their position on political expediency, their reluctance would be more understandable. But I find that hard to believe. I beg to move.

Baroness Andrews: The party of the noble Baroness is nothing if not consistent. This is not the second but the fourth time that both Houses have debated a version of the amendment, which would require the Secretary of State to consider each year whether to exercise the power provided by subsection (2) to set a date for revaluation and, whatever the outcome of his decision, to give reasons for it. In other words, he would have to produce a report annually—or at some other interval—of his consideration and justification.
	The noble Baroness has argued, as she did in Committee, that the amendment is necessary because it would introduce some certainty, clarity and accountability into the process, whereas at the moment the Secretary of State can allow a situation to drift until, at a whim, he decides to impose, without public debate and in isolation, a revaluation decision. She suggested that her amendment would give the country and Parliament an opportunity to consider and to understand the reasons for revaluation, or no revaluation, on an annual basis, and that this would reassure everyone that the right decision was being taken for the right reasons at the right time.
	Before I deal with the reasoning behind the amendment, which I believe is well meant but unsustainable, let me deal with the practical implications, which are not only unnecessary but counterproductive. This amendment is different from the previous one. The noble Baroness removed the reference to house price divergence. We dealt with that comprehensively in Committee, but, nevertheless, removing the dog does not mean that you have dealt with the bark. There is an issue about what else might credibly prompt revaluation, given the rationale for revaluation and its structure and history.
	The noble Baroness has accepted my argument that there can be no one golden rule. Nevertheless, with or without that specific reference to house price divergence, the arguments about levels of divergence would be bound to remain the main focus of the debate. That would inevitably mean that an annual review of this sort would be concerned with divergence of prices. It would occur not only at the point of the year when it was being debated properly, but would fill up the empty months between them, too. As we argued before, that focus would inevitably require us to go through something akin to a full revaluation exercise every year. That seems to me to be a recipe for greater uncertainty and turbulence than anything that we have at the moment.

Baroness Andrews: My Lords, the difference is that the amendment requires there to be an annual debate on whether there will be revaluation that year. I cannot think of anything more destabilising for home owners than to have a debate which will run from year to year about whether there will be a revaluation. I shall come on to argue why I believe that the amendment is unnecessary; indeed, I believe that it is positively harmful.
	I am not simply being perverse in rejecting the amendment on the basis that I have just outlined. I am in total agreement with the need for a mature debate about the reform of council tax. However, I believe that the amendment carries a risk to the stability and credibility of the tax and I wonder whether there will be a risk of unintended consequences on house prices. I accept that the continuation of the council tax is not the policy of the noble Baroness's party, but it is the policy of the Government. We have to make it as credible and as watertight as possible.
	We have to address cost and bureaucracy. Those matters are not minimal or marginal. The real costs of mounting an annual exercise, which may well in certain instances lead to no revaluation, would be extremely expensive. Concerns have been expressed not only by me in Committee, but also by the Opposition Front Bench in the other place, when Mr Syms said that,
	"there is always a danger of insisting on members of the civil service doing a lot of work that does not necessarily need to be done".—[Official Report, Commons Standing Committee A, 15/11/05; col. 9.]
	He was supported by Mr Forth, who noted that,
	"to fulfil the requirements of the amendment, a gigantic bureaucratic exercise would have to be undertaken every year".—[Official Report, Commons, 1/12/05; col. 474.]
	Those are serious considerations. Would that obligation to produce an annual report provide value for money for taxpayers? It might be argued that there is no specific requirement within the amendment that the work required should be particularly expensive, onerous or arduous. However, if the work were not properly done—and to do it properly would require significant investigation every year of matters such as the state of the housing market and a proper analysis of the options and so on—there would not be much point in doing it.
	If we lay that objection to one side, I am bound to say that I see no real justification for the amendment. This would be a statutory requirement to provide specially for a mechanism to require the Government to pronounce in a particular way on a single area of policy, but we do not have a provision with comparable effects in relation to a long list of other areas of policy. For example, I am thinking of the effects on individual citizens of the Budget or the setting of benefit levels.
	That brings us to the nub of the argument. I know that the noble Baroness feels that the Secretary of State might allow the situation to drift indefinitely or act without consideration for the need for public debate and that we might rush through the Lyons report without due parliamentary discussion. I hope that I can address her fears.
	The noble Baroness is also concerned about the potential for the unjustified use of the powers that will be given to the Secretary of State. Those powers relate to an issue of real concern to taxpayers. However, I do not believe that the argument leads to the conclusion that she has brought forward. I believe that it is a question of trust in the system and in the responsible office and person of the Secretary of State. Despite the superficially attractive argument for explicitly providing for regular review and explanation, this House surely, on further reflection, cannot accept its validity. Ministers are accountable for their decisions every day of the week, 365 days a year. They are held to account in a variety of ways by mechanisms that ensure that they act with probity.
	What is the logic of the amendment? These are not entirely new powers; the power of the Secretary of State to bring forward a revaluation within a 10-year timeframe was set out in the previous legislation. All the Bill does is to place that power within a more flexible timetable to signal that we are committed to postponement. Why should that change be singled out for this kind of special treatment? If we legislate for an annual review of revaluation, where logically would we stop? Furthermore, the powers of the Secretary of State are hardly unfettered. As I have already described, they are subject to the affirmative procedure in another place. The proper time for the next full debate is not at some arbitrary moment during the course of every calendar year, but when an order is on the Table with a date for revaluation and a co-ordinated packet of reforms to go with it. Let the noble Baroness be in no doubt that we will have that debate.
	The noble Baroness has implied that decisions on revaluation might be taken in isolation and without reference to public interest. I shall not go into detail, but the point of postponing revaluation from 2007 was to introduce greater certainty, clarity, transparency and rationality into the debate so that future revaluation would be based on a greater and more credible understanding of the functions of local government and the services that it provides. If the noble Baroness reads the interim report, she will see what Sir Michael Lyons says about this. The landscape of local government has greatly changed. To extend the remit to include that while at the same time looking at the revaluation system was logical and transparent. I hope that that is reassuring.
	There is a further argument, which is about the need to provide Sir Michael Lyons with time and space to complete his work and for us to consider and consult on it. This was not a capricious decision. His work, and the whole context of revaluation, must be considered in relation to those who design and deliver services in local government. We have a strong, robust and continuing relationship with local government through the Central Local Partnership. That signifies our intention, which we always express, to work with local government in order to strengthen and sustain it. The relationship is based on trust and partnership. In the light of that, I can reassure the House that our approach to local government finance in the light of Sir Michael's findings will be based fairly and squarely on proper, full, public debate. I hope that the noble Baroness will accept those arguments and will feel able to withdraw her amendment.

Lord Warner: My Lords, I beg to move that this Bill be now read a second time.
	It is a privilege to have the opportunity to bring such an important and indeed historic Bill before the House. The Bill contains a diverse range of provisions aimed at protecting the health of the public both inside and outside of hospital as well as improving the management and efficiency of the NHS.
	I will start with the smoke-free provisions. We have come a long way in recent years, but smoking is still the principal cause of premature death in England. An estimated 85,000 people die every year from smoking-related illnesses, including lung cancer, respiratory illness and heart disease. The estimated cost to the NHS in England alone of treating people with smoking-related diseases is between £1.4 billion and £1.7 billion per year. Only last week research published in the European Heart Journal showed that the UK spends the highest proportion of its healthcare budget on treating cardiovascular diseases of any country in the European Union.
	However, we are tackling head on the problem of smoking. We have already banned tobacco advertising. We have strengthened health warnings on cigarette packets and we have introduced NHS stop-smoking programmes that in 2004–05 alone helped almost 300,000 people give up smoking. With this Bill, from the summer of 2007 virtually all workplaces and enclosed public places, including all licensed premises and membership clubs, will be smoke-free. This will be a major step forward. Not only will we be protecting people from the well documented dangers of second-hand smoke, we will be creating an environment in which smokers will find it easier to give up.
	Of course noble Lords will be well aware of how the smoke-free provisions in the Bill have evolved during its passage through the other place. Indeed, no doubt many of your Lordships will see the changes made by the other place as an interesting reversal of roles. I do not intend to dwell on that point other than to say I hope that this House will respect the divisive—I mean, the decisive—vote—

Lord Warner: These always creep in, my Lords.
	I hope that the House will respect the vote—indeed, it was a free vote—in favour of extending the smoke-free provisions to both licensed premises and private membership clubs. I believe the comprehensive smoke-free legislation that the House will now consider was not just the best outcome in public health terms but also the best outcome in terms of representing the strong public support there is for a total ban. A December 2005 opinion poll commissioned by Cancer Research UK and the public health charity ASH revealed that over 70 per cent of respondents supported a total ban on smoking in public places and workplaces.
	Noble Lords will no doubt also be aware of the strong support the full ban has with those who see at first hand the harm that smoking causes.
	For example, Professor Dame Carol Black, president of the Royal College of Physicians, said:
	"The ban will lead to up to a million people quitting smoking and in the long term thousands of lives will be saved. The UK now recognises smoking as one of our greatest avoidable threats to health and accepts the need to manage it effectively. There are still more measures to be taken and we urge the Government to continue along the path of effective tobacco control. We shall be with them at every step".
	The BMA's head of ethics, Dr Vivienne Nathanson, said:
	"Every day around 30 people die in the UK as a result of second hand smoke. Yesterday's vote will mean the beginning of the end to these frightening statistics".
	Professor Alex Markham, Cancer Research UK, said:
	"This is the most important advance in public health since Sir Richard Doll identified that smoking causes lung cancer 50 years ago".
	Lastly, I quote Mr Peter Cardy, the chief executive of Macmillan Cancer Relief, who said:
	"We are delighted that Parliament has seen sense and has taken the single most effective step it can to cut horrible, painful lung cancer deaths. As Macmillan Cancer Relief knows only too well, smoking and passive smoking cause nine out of 10 lung cancers. This move will, quite rightly, protect the health of staff working in pubs and membership clubs as well as their patrons".
	This is truly an important and historic Bill. Through the smoke-free provisions, thousands of lives will be saved every year and many thousands more people will be spared the misery of watching friends and family die prematurely. Hundreds of thousands of people will be helped to give up smoking and to take back control of their own health. And millions more will be protected from the dangers of second-hand smoke in virtually all enclosed public places.
	Before moving on to the other important provisions in this Bill, I turn briefly to Chapter 2 of Part 1 of the Bill. Here, we have taken a power to enable us to raise the minimum age for sale of tobacco products through secondary legislation. On 8 December 2005, my colleague, Caroline Flint, the Under-Secretary of State for Public Health, announced the Government's plans to hold a full public consultation on whether the age for sale of tobacco products to children and young persons should be raised from the current minimum age of 16. However, discussion of this issue in the other place during the passage of the Bill revealed cross-party support for the Government taking a power now, in the Health Bill, to enable the minimum age to be raised through secondary legislation at a future point. This will enable the Government to take swift action should change be deemed desirable in the light of the consultation without the need for further primary legislation. This consultation will begin shortly.
	Part 2 of the Bill reinforces the measures that we have taken to tackle healthcare-associated infections. I know that this issue remains a key public concern and patients quite rightly expect to be treated in a clean and safe environment. Not all of these infections can be prevented, but minimising healthcare-associated infections is a top priority. That is why we have set a target to halve MRSA bloodstream infections by 2008. We were the first government to require surveillance for MRSA and we are using this data to help drive down infection rates. These actions are beginning to have an effect and some specialist hospitals have shown particular progress. But we are not complacent. The provisions in this Bill build on the progress to date and will further sharpen the focus on infection control in the following ways.
	First, the new provisions will enable the Secretary of State to issue a code of practice on healthcare-associated infections which will be legally binding on any English NHS body. The code is based on existing best practice, and a draft was well received when it was consulted on earlier this year. Copies of the latest version of the draft code are in the Library.
	Secondly, we will back this up by giving the Healthcare Commission new duties to ensure that the relevant NHS bodies observe the code. Thirdly, where the commission feels the code is not being properly observed, it will have the power to serve an improvement notice where it judges that this is the most appropriate course of action.
	Finally, if there are significant failings in the provision of health care involving performance against the code, the commission will be under a duty to report this to the Secretary of State, and to monitor in the case of NHS foundation trusts. The commission may recommend that we take special measures to remedy the situation. The measures we decide to take in response to a report could range from practical assistance, such as drawing on the support of a trust that has successfully implemented the code, to more formal intervention at board level.
	The provisions in the Bill will build on existing good work to give a firm statutory footing to good practice in infection control and hygiene practice in the NHS. We will have clearer direction and tough sanctions for trusts that fail to deliver. I am confident that the code and the new powers for the Healthcare Commission will ensure that patients receive the quality of care in this important area that they rightly expect. I note that the Opposition health spokesman in another place, Andrew Lansley, emphasised at Third Reading the necessity for the measures described in the code.
	Part 3 of the Bill deals with drugs, medicines and pharmacies. This includes provisions to strengthen the management of controlled drugs throughout the UK, in response to some of the shortcomings identified by Dame Janet Smith in the Shipman inquiry's fourth report.
	Many improvements in clinical governance have already taken place since Shipman was practising, but this legislation will bring a greater focus to the management of controlled drugs in particular.
	The Bill gives every healthcare body a duty to appoint an "accountable officer" to take personal responsibility for the use of controlled drugs within that organisation. There will also be a new duty on all NHS bodies and relevant local organisations to share intelligence and agree joint action where there are concerns about the misuse of controlled drugs. I am confident that this legislation will strengthen the safeguards against that very small minority who would divert these drugs for personal abuse, financial gain or, in a few rare but extreme cases, criminal purposes.
	The remainder of Part 3 and Chapter 1 of Part 4 of the Bill deal with pharmacies. It has long been recognised that we are not making best use of the pharmacy workforce, particularly in community pharmacy. To address this, the provisions in this Bill will free pharmacists throughout the UK from the dispensing bench so they can expand the range of services that can be provided from the pharmacy. There are services that can add real value to the health of the community, such as advice on smoking cessation or medicines-use reviews for patients with long-term conditions. And we know from our "Your Health, Your Care, Your Say" consultation just how well regarded our community pharmacists are, and that many people really appreciate the advice and help pharmacists can give.
	At the same time as freeing up the pharmacists, we are also reforming the entry requirements for the provision of pharmacy services across England and Wales. The Bill implements the final elements of a balanced package of reforms for England in response to the Office of Fair Trading's 2003 report on the restrictions on NHS pharmacy applications known as "control of entry".
	I read with interest the debate in the other place on the ophthalmic provisions in this Bill. Quite rightly, there was acknowledgement that we have some of the best ophthalmic services in the world. But there was some concern and misunderstanding that the provisions in this Bill are seeking to tamper with this excellent service. This is not the case. What we are seeking to do is remove restrictions on whom PCTs can contract with to provide the sight-testing service to reflect the reality of service provision and help to facilitate market entry.
	Secondly, the new framework for ophthalmic services will also permit the commissioning of enhanced services or additional services—the type of services that are often available only in the less convenient secondary care setting, but doing this within the community setting. That is what our review of ophthalmic services is looking at: how we can make better use of the skills and resources in the primary care setting. The provisions in this Bill simply provide a new framework for such services to be provided. While PCTs have some powers to commission enhanced services, we think that a more coherent and flexible framework, such as that used for other primary care services, will support that activity and help PCTs to deliver better care for patients. In particular, there will be powers to require the provision of additional ophthalmic services across England. The new framework clearly provides opportunities for primary ophthalmic providers to provide a much wider range of services. Currently, the 1977 Act provides only for the commissioning of the sight-testing service.
	I know that there are been concerns about whether the new framework will mean that we move away from the current nationally negotiated contract and central funding arrangements for the sight test. On that point, I reiterate what my colleague, Caroline Flint, said in the other place. We have no intentions to move away from how the sight-testing service currently operates; in other words, patients will be able to choose their general ophthalmic services contractor and contractors will be able to have a general ophthalmic services contract, provided that they meet agreed national criteria, subject, as now, to local decisions on matters such as quality of service. We also plan to continue to have a centrally negotiated and funded sight-test fee with access to sight tests not being constrained by individual PCT budgets. These provisions will help PCTs to deliver better outcomes, more choice and even more convenient ophthalmic services for patients, and provide a real opportunity for providers of primary ophthalmic services.
	I turn to the protection of the NHS from fraud. The Bill will give the NHS Counter Fraud and Security Management Service modest new powers to continue to fight fraud in the NHS and to make it a safer place to work. The counter-fraud service has been highly successful in ensuring that money provided for provision of healthcare services in the NHS is spent as intended and not lost to fraud. By the end of the last financial year, it had produced a financial benefit of £675 million, which represents a 13 to one return on its total budget since 1999. Its role in deterring fraud is considerable. The new provisions in the Bill will simply enable the counter-fraud service to require the production of documents relating to specific investigations, such as asking for the pay records and duty roster of a private care home when an NHS employee has been working while also claiming sick leave from an NHS trust. It will not include powers of entry, search, seizure or arrest. In that respect, the counter-fraud service will continue to be supported by the police.
	The last substantive part of the Bill is Part 5, which will establish a new non-departmental public body, the appointments commission, to replace the current NHS Appointments Commission. These provisions respond to the Public Administration Committee report in 2003 on Government by Appointment. The committee found that the NHS Appointments Commission was working well and that other government departments could benefit from using its services. This Bill provides the legal framework to do just that and reconfirms our commitment to an independent appointments process.
	There are also a number of minor and technical provisions in the Bill relating to the administration of the social care bursary scheme; the audit arrangements for special health authorities; the injury cost recovery scheme in the NHS; the transfer of criminal liability in the NHS; and provisions to remove out-of-date references to Welsh health authorities. I shall not go into any further details here.
	In conclusion, this is an important and wide-ranging Bill that will have a tangible impact on the health of the public both inside and outside the hospital setting. It will remove tobacco smoke from virtually all the country's enclosed workspaces, leading to an estimated 600,000 fewer smokers, more lives saved, and up to £100 million per year in savings to the NHS. It will better protect patients from healthcare-associated infections; modernise the provision of pharmacy services, ensuring we make best use of pharmacists' skills; give our counter-fraud service enhanced powers to target those who defraud the NHS; and it will make a number of technical changes to improve the working aspects of health and social care. I commend the Bill to the House.
	Moved, That the Bill be now read a second time.—(Lord Warner.)

Baroness Cumberlege: My Lords, I declare an interest: I chair St George's, University of London, I am a trustee of Cancer Research UK, and am involved in a number of health-related organisations and charities through my company, Cumberlege Connections. I start by thanking the Minister for his very clear exposition of this Bill. It is a complicated Bill. He described it as "diverse", and I agree. It has something like nine component parts. Sadly much of what is in it is to be left to regulation. Like him, though, I believe there are elements in the Bill that will have a tangible impact on the positive health of the nation, but of course there are other elements that will need robust scrutiny and debate. As is customary in this House, we will seek to amend and improve in weeks to come.
	Sir George Young, when a junior health Minister, coined the memorable phrase that a decision at the Cabinet table could do more to improve the nation's health than an incision on the operating table. Yet the Cabinet has had real problems in reaching a decision on smoking. It has been for individual Members of Parliament to decide, and I have no quarrel with that. It is right that in this House we should also have a free vote.
	It is perhaps surprising that it has taken over 50 years of compelling research to bring Parliament to consider whether smoking should be banned in workplaces. For me the hero in all this has been the remarkable Sir Richard Doll, who sadly died last year. This is neither the time nor the place to laud the great man, but I remember his survey of family doctors when I was a child. My chain-smoking father was a participant. He was so convinced by the results that he quit smoking. He urged his patients to follow suit, but the majority were totally unconvinced, and did not.
	The medical profession believed the research was so compelling that the public would need no further persuasion; they would be convinced and stop of their own accord. Some did, of course, and the reduction from 45 per cent of the population who smoked in 1974 to today's rate of 25 per cent is progress, albeit small. What is a concern, however, is the number of teenagers who smoke: 26 per cent, and their number is increasing. Teenagers are not worried by their own mortality, a distant concept, but are obsessed by image, which is of immediate concern. We know that once they have started, it is very hard for people to stop. This Bill, with its emphasis on banning smoking in workplaces, turns smoking from a social activity into an activity for loners—hopefully not a cool image, but one to be rejected by teenagers.
	Having read the brief from FOREST, I have no doubt there will be a debate on the legitimacy of the science. That is inevitable, and robust questioning is healthy. To my mind, however, the two reports of the Department of Health's Scientific Committee on Tobacco and Health are overwhelming in both their evidence and conclusions. I am convinced that second-hand smoke kills; ventilation does not work; smoke-free legislation helps reduce smoking prevalence and does not increase smoking in the home; a comprehensive law would reduce health inequalities; private members' clubs are workplaces too; exemptions discriminate against workers and could lead to legal challenges; partial legislation is unfair, unjust, inefficient and unworkable; a comprehensive smoke-free law will provide an even playing field for business; the public supports going smoke-free; and a smoke-free UK makes sense. My reservations in this part of the Bill are purely aesthetic: they concern the rash of notices that will deface every building. I hope that we will be able to enforce the law with a degree of consent and without plastering every available building with another, bossy, unsightly notice.
	Part 2 is entitled "Prevention and Control of Health Care Associated Infections". Traditionally hospitals have been seen as places for cure, treatment, therapy and respite; places of compassion and care. Today they are seen by some as frightening places, places that harbour hospital-acquired infections. For some people, hospitals are now scary places, to be avoided if at all possible. MRSA is probably the best-known of the superbugs, but we should not ignore the other organisms, such as Clostridium difficile, VRE and Acinetobacter which are causing increasing problems. These and other infections have been emerging over recent years at the same time as initiatives have been under way to try and combat the spread. The Government have been slow to act and the problem has got and is getting worse.
	We have some of the highest rates of MRSA in Europe. The financial cost to the NHS is estimated to be in excess of £1 billion a year. But the cost to individuals and their families is beyond measure. In 1978 Clostridium difficile—C.diff—was first linked to making the elderly sick in hospitals. In Canada, about five years ago, C.diff mutated and started to kill patients, younger people. This new hyper virulent strain has spread down the east coast to the US and has also arrived in the UK. Stoke Mandeville Hospital was the first British hospital to admit publicly to having the strain, which was linked to a number of deaths. This C.diff mutation should be a salutary lesson to us. If a similar mutation was to happen to MRSA and if it were to become resistant to Vancomycin, the antibiotic used to treat MRSA—if VRSA were to get a hold as MRSA has, in the vernacular, we would not have seen anything yet and there would be widespread deaths in hospitals.
	One of the contributory factors to the spread of hospital-acquired infection has been bed over-occupancy. My recent experience when visiting a relative in a private hospital was that every bed was left empty for 24 hours after the patient was discharged and then thoroughly decontaminated. Not so in the NHS, where beds are "hot beds", re-occupied while still warm, which means that the waiting list targets are met in the short term, but it builds problems in the longer term. The Government should view the wider picture and relax some of their targets in the interest of safety and good clinical management.
	I welcome the introduction of a code of practice and the involvement of the Healthcare Commission in its enforcement but I hope that the Minister will take into account the continuing concerns of the RCN as to the scope of the code and give organisations a further opportunity to debate and improve it before the Bill receives Royal Assent. Likewise, the definition of a healthcare-associated infection needs reconsideration.
	Parts 3 and 4 of the Bill have proved controversial. The Royal Pharmaceutical Society has concerns, as do optometrists. I would like to leave the pharmaceutical issues to Committee stage, but regarding the changes to the General Ophthalmic Services the question is: why do the Government want to change an arrangement which works so well at the moment? I have listened to what the Minister has said, but there is still a strong belief that, if the Government allow primary care trusts the powers to limit the availability of NHS sight tests, there is every likelihood that the service will be put at risk. As the Minister has quoted, during the Commons Committee stages, clear promises were given that regulations would be introduced to effectively stop the Bill damaging the service. But it still begs the question why these clauses are in the Bill at all. They put at risk genuine choice for patients, no waiting lists and an opportunity to increase standards.
	Alongside the negative aspects of these clauses there is also a positive side. The Bill allows for an expansion of the service to deliver in England what Scottish and Welsh patients can already enjoy, and I really welcome that.
	Those are not the only aspects of the Bill that I think need consideration; as always, other parts require amendment and improvement. I look forward to a lively Committee, a stringent Report stage and a crunchy Third Reading debate.

Baroness Barker: My Lords, I too thank the Minister for introducing the Bill. At last your Lordships have the opportunity to consider in detail the Health Bill—not the Health Improvement and Protection Bill as it was originally entitled. Clearly, the part of the Bill that has attracted the most attention in the other place is Part 1, dealing with the ban on smoking in enclosed public places. More observant noble Lords will have noticed that my noble friend Lord Clement-Jones, who is part of our DCMS team, is back on a free transfer to the health team because he took the tobacco advertising Bill through this House very successfully and therefore has some form on the subject. I should like simply to make two points and to leave most of the other matters to my noble friend.
	The first is that the smoking ban is a matter of considerable public interest and one on which there has been extensive and well informed public debate. Public opinion, not least as it is reflected by the number of commercial companies that have already introduced voluntary bans, is quite clear and in some respects ahead of Parliament. Should there be a difference between the two Houses on the matter of a ban, I believe that the views of the elected Members of another place should take precedence. I do not believe that this is a matter on which this House has the right to overrule those down at the other end.
	Secondly, this is a matter of public health. The role of government should be to protect individuals who for whatever reason cannot exercise free choice about whether to work or to be in a smoke-free environment, and to address health inequalities. That will be the basis of the Liberal Democrat contribution to this debate and it reflects our policy on the matter.
	I too wish to concentrate on the other parts—the anorak parts—of the Bill, which have received very little attention. However, these parts have important consequences for primary and secondary healthcare.
	The most substantial part of the Bill, as the noble Baroness, Lady Cumberlege, said, is the introduction of a code for infection control. The incidence of infection in healthcare settings has been the subject of extensive political debate, not least during the previous general election, which proved conclusively that the public were not thinking what the Conservatives were thinking. The second national prevalence survey of infection in hospitals, in 1996, estimated that 9 per cent of all inpatients had a healthcare-associated infection. The National Audit Office report in February 2000 reported that healthcare-associated infections were possibly responsible for up to 5,000 deaths per year and the associated cost was £1 billion per annum. Since then there have been a number of initiatives, mostly information and education materials for healthcare professionals, such as Fighting Infections, Winning Ways, Towards Cleaner Hospitals and, in June 2005, the NHS Modernisation Agency's infection control initiative Saving Lives
	Given all that activity, the fundamental question which the House has to ask is what difference will be made by a code of practice that, by the Government's own admission, will place on the NHS a regulatory burden of £34 million annually. When making up their minds, noble Lords might like to consider that the Bill's regulatory impact assessment makes clear that the data on which the code is built is from 1997. Moreover, in the intervening period there has not been a fully reliable system of surveillance of incidence of infection, nor of the implementation of infection control practice within hospitals.
	Perhaps the greatest concern is that there is a dearth of information about the effectiveness of different infection control measures. There is evidence that infections transmitted by hand can be countered by the use of alcohol rubs, and infections in catheter care, which are extremely prevalent, can be reduced by the introduction of aseptic non-touch techniques. In addition, programmes such as UCLH's screening of all patient admissions has worked well, in that it has identified the prevalence of MRSA in other environments such as care homes. One wonders whether greater investment in pilot projects such as that and the eventual roll-out of successful infection control techniques would represent better investment of resources.
	Furthermore, one must ask whether the penalties for non-compliance with the code of practice will simply lead trusts to divert their resources from other means of fighting infection—such as high standards of laundry, ensuring that staff have changes of uniform and facilities in which to change, and 24-hour cleaning services. The noble Baroness, Lady Cumberlege, gave an example; I shall give another. A few years ago, a friend of mine who was in a major London teaching hospital went for a bath and returned to find that her bed had been given to, and was occupied by, another patient. Bed occupancy rates are extraordinarily high in some of our major hospitals. We do not want another lot of centrally set targets that are of no use to front-line staff in trying to combat problems as they meet them.
	A number of organisations have commented on the limitations of the proposals. The RCN has criticised the definition of healthcare associated infection within the code of practice. That organisation states:
	"The definition as currently drafted appears to confuse what a HCAI is with how you come to acquire such an infection".
	That is an important distinction when one is attempting not just to identify but to control infection. Many organisations have criticised the fact that the code of practice will not apply to non-NHS facilities such as independent care homes. That is remarkable, given the incidence of MRSA among care home residents.
	Our policy has been to give those in the front line the support and freedom of action to do what is necessary to fight infection where it occurs. We would ensure that information and training would be available to all staff to enable them to implement effective good practice. Staff would have discretion to close wards or set up isolation units as necessary. We would also ensure that effective systems of feedback and monitoring were in place, so that a sound evidence base of practice could be built.
	In 2003, the Government gave £12 million of pump-priming money to pharmacists to set up a system of surveillance of the use of antimicrobials. That money is coming to an end and I would like to know whether that extremely successful project will be extended.
	Our view is that a code of practice, which is to be introduced immediately, whether trusts are ready or not, and which focuses on processes rather than outcomes, is likely to be of limited use; but we accept it as far as it goes.
	The new measures on supervision and management of controlled drugs are to be welcomed in that they incorporate many of the findings of part four of the Shipman inquiry. No system should be designed on the basis of the actions of one extraordinarily evil man; however, reform is necessary. We welcome the proposals in the Bill to the extent that responsibility for medicine management remains within organisations but wish to ensure that there are clear lines of accountability. We note the responsibility placed on the Healthcare Commission to review performance of each NHS organisation. However, I would also like to ask what role the Royal Pharmaceutical Society inspectorate will have in monitoring and policing the actions of NHS bodies. After all, that is the body with the relevant experience.
	The proposals to change the control on supervision of pharmacists, as the Minister has said, are the subject of some concern. Pharmacists do not simply fulfil prescriptions; they play a very important role in talking to patients and checking for adverse drug reactions, which are often not obvious until repeat prescriptions have been issued. To do that, pharmacists need face-to-face interaction with the people they serve. The proposal that registered pharmacists may oversee more than one pharmacy has caused some concern.
	We seek to scrutinise in detail the provisions on the review of the General Ophthalmic Services. We are concerned that the Bill may limit access to general optometry, which is vital not just for eye care but for diagnosis of conditions such as brain tumours or glaucoma. Furthermore, we seek to probe exactly what constitutes additional and enhanced services under the GOS contract. Will conditions such as glaucoma be part of those additional and enhanced services?
	I have one minor question to the Minister. The administration of the social care bursary scheme is to be moved to NHS bodies. I am not clear from the limited statements in the Explanatory Notes why that is possible or necessary. Why should one discipline issue bursaries for another?
	With the exception of the smoking ban, this is not a strategic Bill. The noble Lord, Lord Warner, called it a diverse range of provisions. I would call it a collection of bits and pieces. It needs improvement and bits of it may well need protection during its passage through this House. Overall it has our support, but we will seek to strengthen it as it passes through your Lordships' House.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Warner, for explaining this Bill so clearly. When the Health Bill appeared in the Printed Paper Office just before the half-term break, I thought, as I suspect others did too, "Not more changes to the National Health Service". But some of the additions in this Bill, such as restrictions on smoking, will be of great benefit to many people. Changes of membership of bodies and appointments to bodies, however, always seem to take the concentration away from direct patient care.
	Part 4 of the Bill deals with pharmaceutical services and makes changes to enable PCTs to consider, in their assessment of applications from pharmacists to provide NHS services over the counter, medicines and other healthcare products. It is the other healthcare products that I query. There is great concern that the Department of Health, having conducted a consultation exercise, is considering options for changing Part IX of the Drug Tariff. There are concerns about the proposals for change in the consultation on arrangements for the provisions of dressings, incontinence appliances, stoma appliances, chemical reagents and other appliances to primary and secondary care.
	The Patients Industry Professional Forum consists of medical professionals, patients and patient representative groups. Representatives from industry have been in touch with me. They say the consultation fails to acknowledge the demand for, and the necessity of, the essential services currently provided for patients by companies in this sector. Such services include the home delivery of appliances required by stoma and continence patients and the provision of specialist stoma care nurses, who care for patients by providing bespoke services such as the measuring and fitting of their appliances.
	The thrust of the Government's approach appears to be based on the opinion that the payment received by member companies that provide such essential services—known as dispensing appliance contractors, or DACs—should be the same as that received by high-street pharmacists, who do not provide such services. The members of the Patients Industry Professional Forum recognise that within the patient population will be many patients who wish to obtain their necessary prescriptions over the counter. However, for a large number of patients, such a service is impractical and inappropriate. Unfortunately, my husband is one such patient. The services provided by member companies in this area bring significant benefit to a sensitive part of healthcare, which much of the population does not understand and still finds embarrassing to talk about. New patients are recovering from the mental stress involved in facing up to serious illness, as well as the physical stress involved in recovering from major surgery. The support given by the specialist nurses is invaluable to carers, too.
	The Continence Foundation has also been in touch with me. It says that it hears that some PCTs are trying to make significant savings to the budget for continence products and that they are trying to withdraw delivery to people's homes and care homes. In a rural area, that would be totally impractical. On Friday, 17 February 2006, the headline of The Times read:
	"Thousands threatened by oxygen shortage. Woman dies as 'chaos' follows privatisation of vital NHS supplies".
	Surely we cannot continue with the Government telling us that it is up to individual PCTs. The public are worried about the fragmentation of these vital services. Do the Government and the Minister not want to protect these most vulnerable patients? We need some amendments to protect them and to make PCTs realise that they have a duty of care to provide these vital services.
	I am delighted with the progress in this Health Bill in making many premises smoke-free. All my life, I seem to have been trying to dodge smokers. For years, I have served on the board of visitors of a young offender institution. I have always felt that not enough has been done in health promotion in the Prison Service, especially with regard to the dangers of smoking. I ask the Minister to clarify the exemptions to smoke-free premises in Chapter 1, Clause 3. Will the Secretary of State for Health be able to make some specified areas in prisons and other institutions smoke-free? If prisoners who are non-smokers are banged up in a cell with a heavy smoker for long periods, that must be totally wrong now that the health evidence is so clear. Would it not be possible to make smoke-free wings in prisons and ban smoking in all eating areas and also in visiting areas, where there are often children and where staff are always on duty?
	I often interviewed young people who were non-smokers. Those who are trying to stop smoking should be given as much encouragement as possible. I hope that the Secretary of State will make appropriate regulations. I hope, too, that in care homes people who do not smoke are given a smoke-free environment to eat and socialise in if they so wish.
	Part 2 of the Bill introduces new provisions on prevention and control of health care associated infections. I am pleased that this important part of health care is in this Bill. On 4 November 1996, I had an Unstarred Question debate on MRSA and infections that were resistant to antibiotics. The late Lord Fitt, who had recently lost his wife from MRSA caught in the Chelsea and Westminster hospital, spoke movingly, and the debate was well reported by the press. Since then, there have been several Select Committees and debates in both Houses of Parliament, and conferences throughout the country on infection control. Infection control is now firmly on the health agenda, and I am pleased that the Bill incorporates the issue. It is important to cover it by legislation. There are many different clever bugs—not just MRSA—not only in hospitals and other health facilities, but in the community. The public are now critical of dirty hospitals, and I am glad to say that the hand-cleaning campaign has now taken off, but not without a lot of hard work from many people working in the area of infection control, including the Royal College of Nursing with its Wipe it Out campaign.
	The Secretary of State will have the power to issue a code of practice, which I hope will include some basic needs. Only on Sunday evening, I was telephoned by a carer of a very disabled man. She said that his wife would not be given gloves that had been supplied to the carer for cleaning up the patient. He has 24-hour care, and has had MRSA twice. He has a peg in his stomach to feed him. To stop supplying such aids used for the prevention of infection seems unwise.
	I was told by a GP receptionist a few days ago that the NHS did not supply sterile swabs. Knowing that to be untrue, I told her that the NHS might be short of money but it had not yet reached that desperate state. GP practice receptionists should not be giving out false information. Otherwise people will not realise the importance of sterile procedures for vulnerable patients.
	There must be more training on infection control for everyone. I give those examples to illustrate what can happen at the grass roots. There are several areas in the draft code of practice requiring much greater clarification and definition. They include hospital design, staff to patient ratios, bed occupancy rates, isolation facilities, the timely management of patient care, clean air environment, hand-washing, and the correct clothing for medical and nursing staff—no rings, no ties—cleanliness of wards, beds, trolleys, curtains, door handles, and so on, and adequate laundry services. Clinical waste must be disposed of effectively and appropriately.
	Often there is a problem in the community. Infections can set in on a Friday or at the weekend. Doctors have to give a wide spectrum antibiotic instead of the most sensitive one for the infection, but the problem is that GP surgeries close on a Friday evening. If there were more testing facilities for infections of all sorts, with quick test results, fewer infections would become resistant to antibiotics.
	I am pleased that the Bill is trying to address the horror of Shipman, but with the increase in the number of elderly patients, there will be plenty for the accountable officer to do. There have been some disturbing cases in the north, with nurses abusing vulnerable patients with controlled drugs. The recent report on care homes and abuse through administering incorrect medication needs urgent attention. With so many demands and an increasing amount of patients of all sorts, I hope that the Government will not rob the most severely disabled people of their vital services. I hope that the Government will not forget that some patients need looking even though the current message coming down from on high is that people should be capable of looking after themselves. There are some very concerned patients and carers who need reassuring. I hope that the Minister can give them that today.

Lord Patel: My Lords, I, too, thank the Minister for introducing the Bill. I strongly support it and, unusually, congratulate the Government, particularly on bringing in comprehensive legislation prohibiting smoking in all enclosed public places.
	I declare an interest: I am vice-president of the charity QUIT, which has helped thousands of people to give up smoking. Today's legislation will help hundreds of thousands more to give up and will go a long way towards meeting government targets for reducing the incidence of smokers in the population.
	I agree with the scientific evidence cited by the noble Baronesses, Lady Cumberlege, Lady Rendell and Lady O'Cathain. Anybody who does not agree with the overwhelming scientific evidence of the damaging effects of second-hand smoke has his head in the sand or is confused by facts.
	I am pleased that the Bill was amended in the other place to remove the opportunity to exclude private membership clubs and any licensed premises. All public places should be smoke-free, including all areas of the Palace of Westminster. I would go further: Parliament should set an example, as have hospitals, and ban smoking in all parts of the Palace of Westminster, including offices. I support these measures.
	Part 2 relates to the prevention and control of healthcare-acquired infections. I welcome and support this part of the Bill as well. Again, I declare an interest. I am chairman of the National Patient Safety Agency, an organisation that has done a considerable amount, particularly with its "clean your hands" campaign, to help to reduce healthcare-related infections, as the Minister is aware.
	I have some questions about the scope of the code of practice, which others have mentioned. The code is not available to us now, but it would have been better to have had it to enable us to comment on it when debating the Bill. I hope that the Minister will comment on that and that we will have the opportunity in Committee to probe further on the scope of the code of practice on healthcare-acquired infections.
	I also have concerns about the definition of healthcare-associated infections. The definition in the Bill refers to any infection which an individual "may be" exposed to. The definition used by the Health Protection Agency is much better and does not include the words "may be". Again, we will have an opportunity to explore this further in Committee.
	I support Clause 15 on the functions of the Healthcare Commission in relation to the code of practice, as the body which ensures compliance with the code. There are, however, issues to be discussed with regard to improvement notices—for example, the length of the specified period which an organisation must meet to comply with the notice, the redress open to the Secretary of State if the organisation does not comply, and so on. What are the likely effects of the code of practice on the training of health professionals, and will it require more resources to implement them?
	Part 3 of the Bill refers to drugs, medicines and pharmacies. This part of the Bill is in response to the fourth report of the Shipman inquiry and relates to the safe management and audit of controlled drugs. It is right that an accountable officer should be responsible for ensuring the safe use of controlled drugs and for best-practice guidance on the handling of controlled drugs. We have examples reported to us by the National Patient Safety Agency in relation to the harmful effect of some controlled drugs, which will soon be out as an alert to the service.
	As I said in the beginning, I welcome the Bill. Apart from some areas requiring further clarification, I shall support it. In bringing in part 1, which relates to smoke-free premises, the Government have made a greater contribution to public health and health gain than any government in decades.

Baroness Murphy: My Lords, noble Lords may be relieved to know that I am not going to talk much at all about the smoking business. My views, both as a doctor and a chairman of a strategic health authority are so predictable that you could almost take them as read. I congratulate the Secretary of State, Patricia Hewitt, for finally voting against her own department's original proposals—although I was sad to see that one health Minister did not support the healthiest option of smoke-free public premises. I hope that that particular Minister will not be around monitoring the performance of my authority on our smoking cessation targets.
	I add my voice to the voices of the noble Baronesses, Lady Rendell and Lady O'Cathain, who raised the issue of providing better protection for residents of care homes and nursing homes, who often have to suffer the smoking of other residents and staff. I have regularly witnessed that in registered care homes and nursing homes, and we must find some better way in which to protect those individuals.
	As the noble Lord, Lord Patel, said, this is probably the most important public health measure proposed in the past few decades, and I strongly support the Government's current proposals.
	I turn to the new pharmacy regulations, and hope that the Minister will be able to put my mind at rest on a few points. First, I want to say how much I welcome the new pharmacy strategy and the new proposed wider role for community pharmacies in primary healthcare, and to support the increased contribution that they can make to public health and possible practice. We have 37,000 pharmacists in the UK; highly trained, skilled professionals whose talents are often underutilised under the current arrangements.
	Those noble Lords who have visited Italy, France and many other European countries will know that the local pharmacist often plays a key primary care role, and is expected to give advice and guidance on a wide range of healthcare matters relating to medicines and products and on public health issues. It is enormously beneficial and easy to be able to consult a high street pharmacist on the spot, and to widen access to pharmacy services must be a good thing.
	On the face of it, the current proposals make a good deal of sense. There will cease to be an obligation for a pharmacist to be physically present at a pharmacy while medicines are being dispensed. There will be a designated responsible pharmacist in overall supervision, but not required to be present at all times. The supervision of the pharmacy may be by remote mechanisms, by robotics, video links, electronic means of viewing prescriptions and so on. But it seems to me—and this has been raised by the Pharmacists' Defence Association too—that the provisions, if not properly implemented, may have the unintended consequence of lessening the public's access to a community pharmacist in more deprived areas and provide fewer safeguards for patients in terms of supervision of their medications.
	The primary role of the pharmacist is to ensure the safe sale and supply of medicines in the pharmacy, and he or she is uniquely qualified to do that. The PDA deals with the many dispensing errors and near-misses, and knows, even though now 80 per cent of medicines are pre-packed and bar-coded, that drug errors still occur, and that technicians and dispensing assistants are not equipped to cope with an unexpected incident where an intervention may have to be made quickly to avoid harming a patient. The prolonged absence of a pharmacist will undoubtedly leave many decisions to assistants and technicians.
	It looks as if it could be possible under these proposals for a pharmacist to supervise more than one pharmacy at once, by being officially in one pharmacy and providing cover remotely as a supervisor at another. I fear that companies with several pharmacies will simply reduce the number of qualified pharmacists they employ in some areas. The commercial reality of the pharmacy industry in inner-city areas, and in some remote rural areas where there are already recruitment problems and great difficulty in finding locums, could lead to the creation of a two-tier system of well staffed and poorly staffed pharmacies.
	I do not want to downplay the skills of our valuable registered pharmaceutical technicians, nor our dispensing assistants, but the fact is that they are at their most useful when they work directly with, and are learning from, an expert pharmacist in a close-knit multi-disciplinary team. How many hours will a pharmacist have to spend in the pharmacy per day or week or month in order to be designated as a responsible pharmacist? Has that been considered with regard to patient safety? Will the Minister explain how regulations can be, as it says in the Government's Health Bill information paper, tightly drawn to ensure that the absence of a pharmacist will be permitted only in specific and defined exceptional circumstances, yet designed to ensure the responsible pharmacist has sufficient time and flexibility to offer other services away from the pharmacy? How can a pharmacist supervise a remote pharmacy over extended periods without compromising safety? How long might he be away for?
	What about pharmacies that open 100 hours a week or more to satisfy the exemption from control of entry regulations to NHS prescribing status? Can we be reassured that there will be one responsible pharmacist for every community pharmacy? Will the Minister clarify under what circumstances a responsible pharmacist could supervise more than one pharmacy? Finally, what is the remote pharmacist permitted to do when he or she is away from the pharmacy? I hope, because this is one of my fears, that it will be providing healthcare rather than simply driving around town between his six other pharmacies.

Lord Geddes: My Lords, I have enormous sympathy with the noble Viscount, Lord Simon. He put his finger on the point: those who do not wish to smoke should not suffer from second-hand smoke, but those who wish to smoke should be allowed to. That is the essence of what we are talking about. I declare an interest as a proud member of the Lords and Commons Pipe and Cigar Smokers' Club, although I smoke neither pipes nor cigars.
	Like my noble friend Lord Naseby, I wish to concentrate on Part 1 of the Bill, particularly Clause 3, which deals with private membership clubs. Clause 3 gives the illustrative example of homes and places of permanent or temporary living accommodation, including hotels, care homes—as the noble Baroness, Lady Rendell, mentioned—and prisons, as places that may be exempted by regulation. As an aside, I can see a farcical situation developing in prisons, where the prisoners concerned can smoke, as they are exempted. But what about the prison warders? That is their place of work. Are they allowed to smoke? Perhaps the Minister could clarify that.
	Clause 3 continues specifically to prohibit the exemption of premises having a premises licence or club premises certificate under the Licensing Act 2003, which includes of course pubs, bars and private membership clubs. There is a special case for genuine private membership clubs. The licensing regime recognises that genuine membership clubs are significantly different from licensed premises. There is a technicality on the two different types of licensing, but I will not bore your Lordships or take up their time on that one. As my noble friend Lord Naseby rightly said, clubs holding a club premises certificate—that is the difference between a normal licensing certificate and one that affects clubs—are run by their members, who choose freely to associate with each other. They are run principally for the benefit of their members, and under their rules there is accountability to the members of the club who determine how the club is managed and operated. Surely a private institution like that can make up its own mind. No one is obliging anybody to become a member of such a club, but if you are a member of a club why can't you indulge in smoking if you so wish?
	I have done quite a lot of trawling of press reports. I do not normally rely that much on what the gentlemen of the press say, so I have tried to give as wide a spectrum on this as I could. I shall quote extracts in no particular order. There was an interesting comment on 19 February from the noble Lord, Lord Rees-Mogg, in the Mail on Sunday:
	"MPs think they have the right to stop us smoking, if we wish to do so, on private premises in the company of friends . . . It is an invasion of private freedom; it is an abuse of power of Parliament, none the better for being carried on a free vote of the House of Commons. They use their free vote to take away our personal freedom".
	I then found one in the Yorkshire Post—not exactly the same as the Mail on Sunday—of 15 February:
	"The smoking ban agreed last night is an illiberal piece of legislation that severely restricts freedoms of choice and the rights of publicans and club owners to run their businesses as they see fit".
	Then from the Sun—normally a periodical or newspaper that I would have thought supported the present Government:
	"We always knew New Labour were a bunch of control freaks. Now, with this ludicrous and unnecessary smoking ban, they stand as out-and-out fascists".
	Switching slightly now, in political terms, to the Times—or maybe not switching; I do not know which way the Times leans nowadays—of 16 February:
	"The pettiness of this official persecution of smokers (who are not prevented from paying a lot of tax) can hardly be exaggerated."
	My final quote is from the Daily Mirror, again not known to be a supporter of this side of the House, whose correspondent said:
	"What riles me is that as part of this government's manifesto, the deal was a partial ban. They lied. Secondly, we, the British public, have laid down, rolled over and allowed our liberty to be taken away".
	I would now like to concentrate on that last point: the manifesto. Again, my noble friend Lord Naseby has done a great service in bringing that to the fore. Let me just quote the relevant sentence in the Labour Party manifesto and then elaborate slightly on that. The manifesto said:
	"In membership clubs the members will be free to choose whether to allow smoking or to be smoke-free."
	The Government have been increasingly praying in aid their election manifesto. As recently as two days ago the noble Baroness, Lady Amos, the Leader of the House, in a slightly testy 10 minutes just after Question Time, prayed in aid with relevance to the reform of this House. That is not the point, but the subject matter is. The point that I submit is that she said:
	"My Lords, government policy on House of Lords reform was set out in a manifesto on which this Government won an election last year".
	In the space of 10 minutes, she used that argument three times. The last of them, chronologically, was:
	"The Government's policy on House of Lords reform remains as set out in our manifesto last year".—[Official Report, Lords, 27/2/06; cols. 11-13.]
	The Government cannot have it both ways. I suggest that there is a certain amount of cherry-picking going on here. When it suits, the manifesto is called in aid; when it does not suit, it seems to be torn up. Other noble Lords may have got the letter that I received this morning. It is on the subject of ID cards, which indeed is coming back to your Lordships' House next Monday, if I remember correctly. It is nothing to do with this Bill at all, but with the point of the manifesto:
	"I believe that Tony Blair and his Government, by stating in their manifesto that ID cards would be voluntary, have created a sense of apathy among the general public, myself included".
	I repeat: either the manifesto is adhered to or it is not, and it was made very clear in the Government's manifesto in May last year that private clubs would be exempted. I certainly will be supporting my noble friend Lord Naseby, if he sees fit to put down an amendment on that subject.
	Just one final comment: it is a personal one and to me rather surprising. My wife is vehemently anti-smoking. She hates my smoking and tells me so on numerous occasions. But when the ban on private clubs was passed in another place some 10 days ago, she went incandescent with rage and said, "How dare they invade the right of private individuals to do what they want on their own premises?" I give that as one illustration and I do not believe that it will be unique.

Baroness Howarth of Breckland: My Lords, although I have an interest in several areas of the Bill, I intend to concentrate at Second Reading on smoke-free public places. I am still trying to work out which of the gods placed me after the noble Lords, Lord Skidelsky and Lord Geddes. In no way will I try to tackle the statistical analysis, although there were moments when I thought that the noble Lord made my point for me. I am grateful that he made more suggestions about how we can reduce smoking.
	This House has already demonstrated that it puts the health of the community first by voting for the London and Liverpool Bills, which await the outcome of this legislation. Noble Lords also voted for smoke-free areas in virtually all parts of this House, showing that they care for their own staff—that is the issue about private clubs—as well as their own health. I had the privilege of taking a leading part on both those Bills and now speak in support of this Bill, so that the legislation can be enacted at the earliest opportunity in 2007 to ensure that all workers have the same level of protection. Although the noble Baroness, Lady O'Cathain, is not in her place, I would join her in trying to ensure that the whole of the Palace becomes smoke-free.
	The BMA has written expressing its delight that Members of the other place opted to put the lives and health of their constituents first and vote for a total ban. Although there were moments when the leadership on the issue looked a little shaky, we were all delighted when the ban went through. That showed that we have a listening government that can look at the facts and change their mind. Whatever is in the manifesto, I thought that listening meant that you were capable of changing your mind during the course of a Parliament. For that I am grateful—after all, you may change your mind about other things, too.
	A partial ban on smoking in public places would have brought nothing but unworkable chaos and the most disadvantaged in our society would have continued to be at the greatest risk. Therefore, I hope that Members of this House will not try to introduce amendments to raise sectional interests—although I understand now that they will. I have no sympathy for the arguments on behalf of private clubs. I have talked to workers who work in private places. Of course they say, "Yes, I think it's alright", until you ask them privately. They say it is alright because they know that they will lose their jobs if they say that it is not alright. I have examples.
	It would be inappropriate for me to repeat the vast array of evidence that we outlined in the London and Liverpool Bills, but some facts bear repeating. The research published by the British Medical Journal last year—and I hope that these are the right statistics—showed that second-hand smoke at work is likely to be responsible for the deaths of more than two employed people in the United Kingdom every working day. That is 617 deaths a year. If you start to divide that up into tiny proportions of hours and days it may seem small compared with the whole population. But I thought that in areas such as this we worked on the precautionary principle—that we care about our community. It is, I hope, the same attitude that we took in relation to BSE and vCJD. Certainly, there are not thousands of people dying from vCJD, but I hope that we continue the precautionary principle to ensure that people do not die from that terrible death any more than from the terrible deaths I have seen from diseases such as cancer that have resulted from smoking and, I believe, secondary smoking.
	Professor Vivienne Nathan, director of professional activities at the BMA, wrote me a telling letter. She stated:
	"The health evidence that second hand smoke kills is beyond dispute"—
	that is the view of the BMA—
	"but doctors' knowledge does not just come from scientific papers—we see the evidence in the lives of our patients and their families. We see that the least affluent patients bear the heaviest burden of the disease from smoking and second hand smoke, and know that this suffering is preventable".
	I know that the positive effect on bar sales has already been mentioned, and maybe some of us have views about alcohol in relation to that, but it shows that business has not been particularly affected by a ban. What about compliance? In the debate on the London Bill, noble Lords said that no one would do any thing about it. People will not comply, they said.
	However, in March 2005, a report, Smoke-Free Workplaces in Ireland, A One-Year Review, contained the following key findings. Compliance with the smoke-free workplace legislation was very high—94 per cent of all workplaces inspected under the National Tobacco Control Inspection Programme were smoke-free; 92 per cent of all workplaces inspected by the Health and Safety Authority were smoke-free; 93 per cent of all hospitality workplaces were smoke-free. There is in Ireland overwhelming support for the law, with 98 per cent of people believing that workplaces are healthier and 96 per cent of people considering that the smoke-free law is a success. In addition, air quality in pubs has improved dramatically and more people like to go to them.
	I know that the issue of ventilation has been raised and I was not going to speak about that, as I talked about it in the debate on the London Bill. However, I have to tell the noble Lord, Lord Naseby, that an atmospheric physicist, James Repace, looked at the need for ventilation in smoke-filled rooms and what recycling that smoke would require. He said that it would take an air recycling rate of tornado-like force to remove all the effects of secondary smoking. I thought that it might be worth the expense of watching some people try to light up in that situation. But that is what the physicist said—and we are talking about physics, not chemistry, anyway.

Lord Monson: My Lords, I declare my usual wholly non-financial interest as president of the Society for Individual Freedom and a supporter of FOREST, although, of course, neither of those offices affects what I am going to say in any way. The fact that I am also a light smoker may do so to some extent—although I would hope that, even if I were not a smoker, I would stand up for individual freedom in the same way that the noble Lord, Lord Naseby, has, and the noble Lord, Lord Stoddart of Swindon, will do shortly.
	When this Bill received its First Reading in another place, I suppose it was correctly titled. It contained many inconsistencies and illogicalities, and was illiberal in many respects—but then illiberalism is par for the course where much recent government legislation is concerned. However, the legislation that has emerged from the Commons can be better described as a health fascism Bill and a slap in the face for the Labour manifesto on which this Government set such store. It embodies a puritanical zealotry we have not seen in this country for 350 years. As the noble Lord, Lord Rees-Mogg, wrote in the Mail on Sunday on 19 February, under the headline, "The week our freedom went up in smoke",
	"The House of Commons is full of busybodies . . . looking around eagerly for [any] . . . opportunity to bite into personal liberty . . . The ban on smoking in enclosed public spaces and workplaces . . . is an invasion of private freedom . . . [and] an abuse of the power of Parliament . . . They [MPs] use their free vote to take away our personal freedom".
	It is interesting to know how many of those who voted to shackle traditional English freedoms represent Scottish, Welsh or Northern Irish constituencies.
	We can all agree on one thing: when people's eyes, ears or nostrils are irritated by other people's habits, as so often happens, they normally have to suffer in silence through gritted teeth. So, if just one of those habits can be deemed not merely irritating but positively lethal to bystanders, it is only natural that the sufferers should take the opportunity to press for the habit in question to be heavily curtailed in their presence—however little truth there may be in the mortality claims. The operative words here are "in their presence". To a very large extent, this has already happened. For example, by 2004, smoking in the workplace for 92 per cent of the population was either banned or confined to segregated smoking rooms. Those who are especially sensitive to smoke, like the noble Baroness, Lady O'Cathain, will surely concede that life is very much more agreeable for people like her now than it was even five years ago, let alone 25 years ago.
	As the general public is much more tolerant than the current House of Commons, only 31 per cent of people want a complete ban in public places. Five per cent want no restrictions and a majority is entirely happy with separate smoking and non-smoking rooms in pubs and suchlike. According to the Office for National Statistics—and who could be more impartial?—this contradicts the claim made by the noble Baroness, Lady Cumberlege. But as the noble Lord, Lord Skidelsky, has already hinted, the long-term and indeed the medium-term, aim of the zealots is to turn all smoking into a shameful, outcast activity, indulged in furtively by men at street corners with their coat collars turned up as if they were peddling hard drugs or pornography. In other words, it is a form of psychological warfare directed against smokers. No matter that most of the men who fought in the trenches of Flanders in the first world war were smokers and honourable men. No matter that most of the men who fought in the second world war across the north African desert, up the spine of Italy, on the beaches of Normandy and in the jungles of Burma were smokers and honourable men, as were those who fought in the Battle of Britain. No matter that Winston Churchill, Clement Attlee and Harold Wilson, all enjoyed their pipes or tobacco, as the case may be, and lived to the ages—note this carefully—of 90, 84 and 79 respectively. No doubt their pleasures will soon be literally airbrushed out of history, as Franklin Delano Roosevelt's perpetual cigarette holder has already been airbrushed out of history in the United States. Judging by what the noble Baroness, Lady Howarth, said, she would be quite happy if airbrushing took place in this country.
	The zealots hope to achieve their aim by claiming, which Professor Sir Richard Doll and Professor Sir Richard Peto never did, that second-hand smoke is so lethal that anyone entering a room, or indeed a company car, which the last smoker vacated possibly several hours previously is in mortal peril—indeed, the noble Baroness, Lady O'Cathain, claimed that 600,000 people a year die from passive smoking, but that figure is larger than the total number of people who die in Britain every year from all causes.
	If that were the case, virtually none of us would be here today. Anyone born before, let us say, 1955 necessarily, whether they liked it or not—and most of us did not like it—spent their formative years wreathed in other people's exhaled smoke, since, even if neither of their parents smoked, smoking in public places was ubiquitous. Yet our generation—or perhaps I should say "generations"—have statistically lived much longer than anyone predicted, much to the dismay of annuity providers. Incidentally, have any death certificates listed passive smoking as a cause of death? I think not.
	Anyone who doubts the draconian nature of even the original Bill should scrutinise Clause 11 and Schedule 2. By comparison, Clause 13 is relatively mild—albeit wholly inconsistent. It is inconsistent because five and a quarter years ago, on 13 November 2000, the noble Lord, Lord McColl of Dulwich—I am sorry that he is no longer in his place—revealed to the House that non-smoking teenagers who indulged in anal intercourse were twice as likely statistically to die prematurely as teenagers who smoked up to 20 cigarettes per day but took no similar sexual risks. Your Lordships, including many on the Labour Benches, took notice of what he said and voted accordingly. However, new Labour, against the wishes and instincts of old Labour but with Liberal Democrat support, forced that measure through by using the Parliament Act. How odd, then, that a minimum age of 18 is being set for the less dangerous practice while retaining a minimum age of 16 for the more dangerous one.
	One recognises that the Bill has not reached this House as the Government originally intended, but that is largely the Government's own fault, partly because some Ministers changed their mind at the last moment—indeed, some of them changed their mind several times in the course of a day—but partly because, as Terence Blacker pointed out in an excellent article in yesterday's Independent, which I commend to your Lordships,
	"government by anxiety has become a favoured New Labour method of dealing with its more intractable problems. At the first sign of sustained opposition to proposed legislation that would infringe civil liberties and free speech, for example, ministers spoke in apocalyptic yet general terms about security and the threat of terrorism. The right to life was the greatest human right of all became the mantra of the moment".
	Of course, that applies to all sorts of things. It is implied that if Olympic pistol shooters are allowed to practise using .22 pistols in this country, the murder rate will shoot up, and if we were to leave the EU, there would be millions of unemployed and mass starvation, and so on.
	If you consistently frighten people into believing that their safety is in peril, it is bound to rebound on you as a government at some point. Let us hope that in this House we can at the very least restore the Bill so that it goes no further in eroding our freedoms than what was proposed in the Labour manifesto.

Baroness McIntosh of Hudnall: My Lords, when I saw that the noble Baroness, Lady Howarth of Breckland, had put her name down to speak in this debate—which of course she would, given her acknowledged expertise in this area—I got an unpleasant sense that she would return to my very disobliging remarks about her when we both spoke in the debate on the London and Liverpool prohibition of smoking Bills last summer. So, first, I want to take this opportunity to apologise to the noble Baroness for casting aspersions on how she conducted her private leisure activities. Despite that, I am not deterred from raising the issue that she observed I probably would raise, and have raised in the past, in respect of this Bill: the impact of Part 1 on the theatre industry.
	I start by declaring my interests, which include being an ex-member of the board of the Society of London Theatre and a current member of the boards of both the Almeida Theatre and the Roundhouse, which is shortly to reopen. I should also say that I entirely support the Bill. I want to make that very clear from the outset. In particular, I support the aspects of it that relate to the restriction of smoking in public places. However, some difficulties arise from it concerning the presentation of live theatre events, and I want to outline them. Before I do so, however, I should like to associate myself with the remarks of the noble Baroness, Lady Howarth, about our late colleague Lord Stratford. I had wanted to refer, as she did, to the fact that he spoke in the debate that she and I both participated in last summer. It was the occasion of his maiden speech, and it seems to me terribly sad that he was not with us long enough to see this issue, about which he felt so strongly, brought to fruition through a government Bill. We shall continue to miss him.
	Three aspects of Part 1 have a direct impact on how theatre presentations can be brought about. First, the definition of "smoking" in Clause 1 is as follows:
	(a) . . . smoking tobacco or anything which contains tobacco; or smoking any other substance; and (b) smoking includes being in possession of lit tobacco or of anything lit which contains tobacco, or being in possession of any other lit substance in a form in which it could be smoked".
	That definition would, therefore, include the smoking of herbal cigarettes—a matter to which I shall return.
	Secondly, the definition of smoke-free premises in Clause 2 is drawn widely enough to encompass not only the public areas of theatres and other places of entertainment, such as auditoria and foyer spaces, but also rehearsal spaces and all indoor stages or other performance spaces, although I note the potential specified in Clause 3(5) for regulations to allow certain exemptions.
	Thirdly, the requirements set out in Clause 6 for the provision of "no smoking" signs could, as drafted, result in such signs having to be displayed on stage during performances. At this point, I agree wholeheartedly with what the noble Baroness, Lady Cumberlege, said earlier about the necessity to be scrupulous about how we go forward with the issue of signage. It can be a very heavy-handed way of dealing with the obviously necessary provision of information.
	All those requirements put together could seriously interfere with the production of theatre work within which smoking is either specifically indicated in the text or necessary to convey a particular period, atmosphere or character. I think, for instance, of John Osborne's seminal play "Look Back in Anger", with which I am sure many of your Lordships are familiar. It was written in 1956 and, briefly, it deals with the marital difficulties of a young couple in that era. The main character, Jimmy Porter, smokes a pipe. If he were not to do so, not only would a significant element of the play be lost, as many of your Lordships will know, but the author's copyright would be infringed because he specifies that. It would be improper for anyone to remove from the play that aspect of his writing without the permission of those who act for him now—unfortunately he is no longer with us.
	There are many other similar examples but I will not detain the House by repeating them. I simply reiterate the point that I made on the earlier Bill:
	"The Bill as drafted gives powers . . . both to inhibit the process of creating work for the stage and to compromise the integrity of performance".—[Official Report, 20/07/05; col. 1568.]
	I do not think that it is the Government's intention to place unreasonable restrictions on the presentation of live theatre performance. Indeed, I believe that they are already considering the matter. My honourable friend Caroline Flint, in reply to a Question from the Conservative shadow Health Secretary, Andrew Lansley, on 17 January, said:
	"We received representations from the theatre industry to exempt theatrical performances and will take them into account in drafting regulations"—[Official Report, Commons, 17/01/06; col.1307W.]
	Will my noble friend confirm this intention and say when it is anticipated that draft regulations will be available? Perhaps I could further encourage him by pointing out that in New York—a city now notorious for the draconian way that anti-smoking regulations are enforced—actors are permitted to smoke herbal tobacco on stage and in rehearsal, subject only to the proviso that if there is smoking on stage, the public must be alerted in much the same way as they are alerted to the use of strobe lighting or explosive sound. It surely cannot be impossible for this Bill to be amended to create similar flexibilities with appropriate safeguards.
	In case it should occur either to my noble friend or any other of your Lordships—the noble Baroness, Lady Howarth, in particular—that perhaps this suggestion is an evil plot by wicked theatre producers to force their hapless employees into unhealthy practices against their will, I should record that Equity, the actors' union, has also raised these issues with the Government.
	On the question of glamorising smoking, I have some sympathy with the noble Baroness, but there is a difference between an active wish to glamorise the act and simply representing the act as part of a theatre performance.
	I recognise that this is a relatively minor matter in the great scheme of things, but it is not insignificant. The move to end smoking in public places is a hugely important step in promoting public health, as many of the previous speakers have said. It has my full support. None the less, as I have said before, smoking, though dangerous and undesirable for many reasons, has been part of our own and other cultures for hundreds of years and its presence in and impact on art cannot be ignored or legislated away. We need to find acceptable ways of allowing it to be represented. I hope that the Government will feel able either to bring forward suitable amendments in Committee, or to consider sympathetically suggestions from others.

Lord Warner: My Lords, I seem to recall that you described this as a health fascist Bill, but we shall let Hansard speak for itself.
	We could spend a long time debating the figures. I think that the figures are in the public arena. I shall not go over them again. Noble Lords can interrupt me as much as they like, but I shall not go over the figures again. We spent a lot of time on that issue. The information is in the public arena. If people have a thirst for knowledge they can read the documents. They are well set out in the public arena.
	I wish to clarify any confusion over what I said at the end of my opening speech—I do not think that I confused people—about 600,000 lives. I did not say that 600,000 lives were saved. I apologise if I confused people. What I said was what was in the regulatory impact assessment: smoke-free provisions will lead to 600,000 smokers giving up, not lives saved. That is a 1.7 per cent reduction in prevalence. What that suggests—as I also said—is that many lives will be saved in the long term.
	With regard to some of the issues raised by the noble Lord, Lord Skidelsky, and others, this is not a debate about statistics, about how many people died and to what extent their lives were truncated. I ask the noble Lord and others who shared his views to think about how many people will also have the quality of their life affected as they have their life shortened. Many people are in the position of my noble friend Lord Simon. They may have conditions that are adversely affected. There is a quality of life issue and deteriorating health for many people who are afflicted and have to subject themselves to the experience of second-hand smoke.
	The noble Lord, Lord Naseby, is concerned about the SCOTH report and whether information is being withheld from the public. SCOTH has reported twice in the past eight years, in 1998 and 2004. Both reports have been published. They are in the Library. Their case has been set out. People can read it. They can consider whether they accept or reject it. In addition, the World Health Organisation reported in 2002 classifying second-hand smoke as a known carcinogen.

Lord Warner: My Lords, I wish to continue with my speech.
	Let me respond to some other points that were made about the issues around ventilation. I think that the noble Lord, Lord Clement-Jones, put the points in that area very well. There is a total lack of good evidence that ventilation provides a real solution to the health risks associated with second-hand smoke and we do not want to require expensive and potentially useless ventilation equipment, as that would be burdensome to many of the people involved.
	A lot of concern has been raised about the impact on the home of the ban on smoking in public places and the workplace. The evidence from New York suggests that 100,000 people have quit smoking since the ban was introduced there; in Ireland, cigarette sales in 2004 are 15 per cent down on 2003 and, after the first six months of the ban, an estimated 7,000 more smokers have quit than would otherwise have been expected to. That evidence is also in the public arena for the sceptics to consider as they wish.
	Issues have been raised about exemptions. We shall no doubt go into those in considerable detail in Committee, but I should like to clarify one or two points. The noble Baroness, Lady Masham, raised the issue whether exemptions would extend to prisons. Prisons are exempted due to human rights issues, as prisons are a person's residence. However, I can say to the House—and I shall put this in more detail in writing to noble Lords—that the Prison Service management board has set up a working group with the Department of Health to review all the implications of the smoke-free provisions of the Bill with a view to achieving smoke-free prisons, so that certain safeguards are made for prisoners who do not want to be exposed to the smoke.
	Residential care homes are also to be exempted on human rights grounds, as they are the residences of those living in them, but we shall issue guidance to homes on how best to provide protection from second-hand smoke for other residents and for staff. It is not intended to exempt student halls of residence as such; however, an individual student's private rooms would be exempted, as they are the individual student's residence.
	The noble Baroness, Lady Cumberlege, raised a number of issues around teenage smoking rates. What I can say to her is that the prevalence of smoking among children aged 11 to 15 steadily increased between 1988 and 1996, from 8 per cent to 13 per cent, but that since 1996 the rate has fallen. In 2004, 9 per cent of pupils aged 11 to 15 were regular smokers. We seem to have peaked, and the percentages are coming down.
	The issue of smoking in the Houses of Parliament is a matter for the House authorities, not the Government. It is down to the House whether it wishes to set a good example to other people. My noble friend Lady McIntosh raised the issue of the impact on the theatre industry of the smoke-free provisions. We are still considering representations from the theatre industry; we are aware that in those countries that have already brought in smoke-free legislation there are a number of different approaches to smoking on stage. That will be covered in the public consultation on the regulations to be made under the Bill.
	I turn to some of the issues raised around healthcare-associated infections. I would gently say to the noble Baroness, Lady Cumberlege, and remind the House that MRSA took root in our hospitals between 1993 and 1997. There is good evidence on that and we have put that evidence in the public arena. As a Government, we introduced mandatory surveillance, which has now been extended. I shall give further and better particulars on conditions other than just MRSA. We believe that the code will improve hygiene. The fact that we do not know everything about tackling healthcare-acquired infections does not mean that we should not codify what we do know to improve public safety in this area. We know that there is variation across hospitals in the extent to which they have been able to tackle healthcare-associated infections, and we believe that the code will achieve greater uniformity and help to bring up the standards of the less good to the standards of the best. We do not believe that there is any evidence that targets to improve health services have actually had an adverse impact in that area.
	The noble Baroness, Lady Barker, asked why the code did not apply to the independent sector—to residential care and nursing homes. Enhanced standards of infection control should in our view apply in all settings in which healthcare is provided. We will accomplish that through the legal framework of the Care Standards Act 2000, which forms the foundation of the regulation of the private and voluntary healthcare sector and care homes. In other words, the relevant elements of the code will be applied to the independent sector under regulations made under the Care Standards Act.
	The noble Lord, Lord Colwyn, asked whether the healthcare-associated infection code should be delayed until the Bill gains Royal Assent. We obviously want to get this into operation as quickly as possible, but we need to wait until the Bill gains Royal Assent before the new powers given to the Healthcare Commission kick in. But the draft code is already available to all NHS bodies.
	The noble Baroness, Lady Barker, raised some issues around the social care bursary scheme. The transfer is administrative; there is no more significance in it than that. It was a result of the recommendations of the arm's-length body review.
	I turn briefly to a number of issues raised in relation to the Bill's provisions on pharmacy and other areas. I am happy to give the noble Lord, Lord Colwyn, the assurance that the Bill does not affect the work of dispensing doctors. The noble Baronesses, Lady Barker and Lady Murphy, raised concerns about the extent to which people might be put at risk in circumstances in which a pharmacist had responsibilities extending beyond more than one pharmacy. We are trying to ensure that there will be a responsible pharmacist in charge of every pharmacy, even those open 100 hours a week. That pharmacy is expected to be their main place of work. There will be exceptions to the "one responsible pharmacist" rule only in exceptional circumstances. An example already in use in Australia is a pharmacist-controlled vending machine, where the pharmacist safely controls the supply of medicines from another place.
	It would not be sensible to require a responsible pharmacist in that situation to stand by the vending machine on the registered pharmacy premises. The responsible pharmacist will be required to set down procedures and determine which staff are competent to undertake them safely. There are a number of other specifications that would ensure patient safety in this area, and I am happy to put those in writing to noble Lords after this debate.
	I can confirm to the noble Lord, Lord Walton, that we will consult widely on the regulations, and will expect to work closely with pharmacy organisations such as the Royal Pharmaceutical Society of Great Britain, with which we have already been working in preparing this legislation. In those regulations we will clearly define the activities that pharmacists must undertake themselves and those that can be delegated to other competent staff.
	The noble Baroness, Lady Barker, raised the issue of inspection. It is intended that Royal Pharmaceutical Society inspectors will inspect controlled drugs management in community pharmacies as part of their routine inspections of community pharmacies. That will build on their expertise and minimise disruption.
	I tried to give reassurance in my opening remarks about ophthalmic services. This is not the occasion to go into great detail, but I will try to extend those reassurances in a letter to all noble Lords. The noble Baroness, Lady Masham, raised some concerns about stoma service changes. The consultation on that finished on 23 January. Officials have been meeting with patients' groups to explain the next stages. No decision will be taken until a robust evaluation has been made of the consultation's evidence of the impact of any changes on patients. Like her, we are concerned to ensure that changes do not disadvantage patients in this particular area.
	My noble friend Lord Rosser raised an important set of concerns about support for non-executives and the role they play in the running of NHS bodies. He is quite right to raise those concerns, and I assure him that my right honourable friend Patricia Hewitt and I are pursuing the issue energetically.
	I have tried to cover many of the points noble Lords have raised. I am sure we will go into considerable detail on some of those issues, and I have no doubt that we will be batting around figures about second-hand smoke in a very happy manner, but tonight is not the time to re-enter that fray. I will be pleased to write to noble Lords on all the points I have not managed to cover.

House adjourned at seventeen minutes before nine o'clock.
	Wednesday, 1 March 2006.